What conditions does kava kava treat?

What Does Kava Kava Treat?

Kava kava should not be used to treat any medical condition—the VA/DOD guidelines issue a strong recommendation against its use for chronic insomnia, and the FDA warns against its use for anxiety or insomnia due to lack of proven efficacy and significant risk of acute fatal liver toxicity. 1, 2

Historical Claims vs. Current Evidence

While kava has been traditionally marketed and studied for anxiety and insomnia treatment, current high-quality guidelines explicitly recommend against its use:

For Insomnia

• The VA/DOD Clinical Practice Guidelines (2020) provide a "strong against" recommendation for kava in treating chronic insomnia disorder, the highest level of negative recommendation in their guideline framework 1
• Studies demonstrate no benefit of kava over placebo for chronic insomnia disorder 2
• The FDA specifically warns against using kava for insomnia due to lack of proven efficacy 2

For Anxiety

• The FDA recommends against using kava for anxiety due to lack of proven efficacy and significant hepatotoxicity risk 2
• While some older research suggested anxiolytic effects (with 3 of 7 trials showing superiority over placebo), these findings are overshadowed by safety concerns 3
• The American Psychological Association recommends evidence-based psychotherapy (such as cognitive behavioral therapy) and FDA-approved medications as first-line treatments for anxiety instead 2

Critical Safety Concerns

Hepatotoxicity

• Kava carries a significant risk of acute fatal liver toxicity, which is the primary reason for recommendations against its use 2
• Approximately 35 cases of severe liver toxicity associated with kava have been reported in Europe and the US 4
• The FDA has issued warnings specifically about this hepatotoxic potential 2

Drug Interactions

• Kava significantly inhibits multiple cytochrome P450 enzymes (CYP1A2, CYP2C9, CYP2C19, CYP2D6, CYP3A4, and CYP4A9/11), leading to potentially dangerous drug interactions 2
• Kava may potentiate sedative effects through GABA neurotransmission and can increase acetaminophen-induced liver toxicity 1
• Patients taking medications metabolized by cytochrome P450 enzymes face significant interaction risks 2

Perioperative Risks

• The American College of Surgeons and American Society of Anesthesiologists recommend discontinuing kava at least 2 weeks before surgery due to central nervous system depression and cyclooxygenase inhibition 2
• Kava can cause decreased renal blood flow via cyclooxygenase inhibition 2

Evidence-Based Alternatives

For Insomnia

• Cognitive Behavioral Therapy for Insomnia (CBT-I) is strongly recommended as first-line treatment by both the American Academy of Sleep Medicine and VA/DOD guidelines 1, 2
• If pharmacotherapy is needed short-term, low-dose doxepin (3-6 mg) or nonbenzodiazepine receptor agonists receive weak favorable recommendations 1

For Anxiety

• Evidence-based psychotherapy (particularly cognitive behavioral therapy) should be first-line treatment 2
• FDA-approved medications with established safety profiles are preferred over herbal supplements 2

Common Pitfall to Avoid

Do not be misled by kava's over-the-counter availability or historical use—regulatory availability does not equal safety or efficacy, and traditional use does not override modern evidence of hepatotoxicity and lack of proven benefit for insomnia 2, 4